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-------------- --------- --- ......... APPLICATION FOR SANITATION PER"IT Permit No. .�b. /.,..0 ............ ----- ............................... '✓ *WOO in Duplicate) �. /0*14/ ....................... This Permit Expires 1 Year From Date Issued Dete Issued ...... -- -••-�•3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. Loi-Hp olp JOB ADDRESS AND LOCA QN..W.....END......OF........�RF.WB:RT ... RI)......._1LU ----0. ....... .....1:.4 OwnersName.. f..V.. �e ......... ..S...l-.. .................... ��y-----; - r ..........::'>-- --....... Address------..... .... XSl......... .............. 1 .............. Contractor's Name.....:... ... .. - ` RhGLe�.........._t::................ * - Installation will serve: Resid�ce ❑ Apartment H0 p; 'Q�mmeXlhl [};`Trailer Court �Aotel ❑ Ot6er Number of livingnits[-0... Number of bYs m PrivN}e umber of eths .....-.- Lot size ... i. Character .. .................... d k{` f}C Water Supply:: Publics stem Communit f [;'Depth to Water Table Z . Character of soil to a depth of 3 feet: Sa *6relelnS4'nolyrLoam❑ Clay Loam ❑ Clay dobe Hardpan ❑ Previous Application Made: (if yes,date(.. .,w'si }7!`*.•i NO !(Jew Cons+ruction: Yes o FFI /VA: s ❑ No - TYPE OF INSTALLATION AND S>P I'- NS: „f/ ---' (No sepfie tank or eesspo periffe pubh �sew i is available within 200 feet.) , y' pp Septic Tank: /DipArbm rt5' re;I'•well-.. .... .Dista ce from fou dation-.-.JQ......... terial_..Fv . .-. .....A. q} �j -... arfm s... Size..k. .�..x..�_ -..Liquid depth-, r�.•..-�Q. s 9 , Disposal Field: nearestwell... ............Distance from foundation....�Q..� istance to nearest n ...5..� . ,t lines. It,::. .. __..-.....Length of each line...._1D0�fi .-. idth of trdpch..__. . ..-_ ........ype of filter.material.- ..�.N�....Depth of filter material-----4............ otal length.....:.... .. . ........ � � Seepage Pit: t9s+ante �earbs# wdll......................Distance from foundation......y............ i�stppce4artTeiest to ine................. ❑ Nu er o pits..... .........._Lining material................_.-_.Size: Diameter....-. ...............Derpth......... _........_....... �- Cesspool: Distant from crest well.................Distance from foundation....................L ing ma+eriat.......... .. ................ .... ❑ Size: Diam ......................................Depth........................ Y..................Likid Capacity.._.... . '_........gals. Privy: ,,,,Distance from nearest well _........................`..� Dist nce from neares buildi gW:^.'.'............. . - I;,� infer e-'tg'd$e')•est!(o lih'Ib�a.¢_a-t:s:t"' .... ..». .... ............. ... :.............. -----..... . -------- 0 _.. ..._ . . . . Remodeling and/or re airing (describe):.a7R Q ...... pTH...L...4-. _r11 .6..-.....S .P-nc.....16 0......... 0.�.. , . .7Z2_.:. 3� IAs tuo-W... . .---�...... --- r.aj4� ---.1oO........NM� EVE A R- � 1� '- PI ANN..�j FfJR' 'rF-Q.nf R „[ t R. .t.i-------- I .-I hereby certify s pared t LUapplic tion and that the work Will.be,doge in accordan with $Sa oaqu�I Coun}y ordinances, State laaw��sVp✓od ues end egAffa+ions off ,San Joaquin Local Health District. I _�•C (Signed)--rR '.... ... -- . ..... ..........__.... ..................---- ...... - ....._._._.........- - ner dT Q,c tractor) b ., (Plot plan, sho six lot, location of system in elation fo wells, buildings, etc., can be placed on"reverse side). -�-a FOR EPART ENT USE APP441 5 h ACCEPTED BY....._.-l--f-J.1,.0! . . ........ ................ .- ........ . v ATE.. .... � �_----- --- BY......... . . _ ......REVIEW - .. ---...... ....... DATE...........1................................. ........-.. _ BUILDING PERMIT IN.... ..�€A. .� ISSUED..... ............. ....-........ _ .......... ..............---•--- ................... AE...._..... ......------------------------.. OAlterations and/or recommendations:..... -..- . f•;...-A --.....7 f.... Pl 6 ..._........ ce ----- .T.. SLY fQ . ..-.-.. .. Svc .-......�1,.t5_. .TRO ....... . ........ .... ....... ................ ........................... .......................... ......... _.._,..... r. -...............t;...... . ............................................ . ... g Y. d t- :FINAL INSP TION BY- ( ...... .... Date..___ 4 3 .. � -._.. ...... r SAN JO11 LOCAL HE TH#DISTRICT C n 1 1 1601 E.Hacelton Ave. 300'Waif Oak SOW I r� 1 1144 SyiarK.re street ,d 405 Wast 9th Street Stockton, California Lodi,California'* Mrteca,California Tracy,California ES 9 REVISED e-S9 3M 3-'63 F.P.Ca.